Apparatus for administering gas



Dec. 3, 1929. A. B. DRGER APPARATUS FOR ADMINISTERING GAS Filed April 22, 1926 l 1 M l 3 9M 0.a 1+ f .vl e E f m 6 W 4 mlmw/,m l l l l 3 M.. w z R W '/l :i131: ll. Vmf 7 .y 11,/ L ILP 3 7 H/ly/ IWMIV 3 y Vm/ 4 7 l im M m 5 l/ n 9 A 9 7 n .d /l 2 4 w1 4 l. nv l 3 4 ,00 4 I u 6 5 4 l 7 mf 7 (Il. 1 0 l Patented Dec. 3, 1.929

PATENT I OFFICE ALEXANDER BERNHARD DRAG-ER, 0F LBECK, GERMANY; ELFRIEDE DRGER, Nr:

STANGE, EXECUTRIX OF SAID DRGER,

DRGER, or Lennox, GERMANY DECEASED, ASSIGNOR TO HEINRICH OTTO APPARATUS FOR ADMINISTERING GAS Application led April 2.2, 1926, Serial No.

Incisions or operations on the sternum or the thorax must be carried out at a pressureA above atmospheric there beingthe danger of collapse of the lungs. The pressure above 5 atmospheric, which I term super-pressure to the respirating members, however, is not resorted to until the moment the breast cavity is opened or the incision is made, when the outer air enters the breast cavity. From the beginning of the .rarcosis up to this moment the patient must breathe without super-pressure. It is true super-pressure narcot1c apparatus were known heretofore, which could be operated so as to make possible breath- `.ing without a super pressure. With these apparatus the. total amount of air required by the patient'must correspond with the amount of narcotic gas supplied since the latter after exhaling passes out into the open airl or into the super-pressure chamber. Moreover it was always a question of vaporized or atomized liquid narcotics which were mixed or may be mixed with the stream of air producing the super-pressure, because the inhaled absolute amount of narcotics was to be taken into consideration to a greater extent than its degree 'of dilution with the air. To secure a super-pressure which is not subj ected to any troublesome fluctuations of pressure in full inhaling and exhaling, either a voluminous cushion of air was necessary or at least sixty liters of super-pressure nar-l cotic gas per minute. y

The invention relates to the use of a gaseous narcotic (such as acetylene, ethylene, laughing gas) mixed in a certain proportion with oxygen. For divers reasons the known apparatus mentioned above cannot be used for the present purpose. The high price of the narcotic gas does not permit the use of sixty liters of gas per minute to avoid the fluctuations of pressure to be taken from the storage of gas; the required amount of breathing may not be supplemented 'from the super-pressure air space, because no dilution of the gassconcentration is permissible; the room in which the operation is carried out may not be filled during the operation, which generally takes rather a long time, with a considerable amount of unconsumed narcotic 103,681, and in Germany October 1, '1925.

gas, to avoid a molestation of the physicians and a danger of explosion.

By the novel apparatus constructed according to the present invention all necessary requirements are fulfilled, such as a small consumption of gas, separation of the breathing gases from the super-pressure current, ngl igible fluctuations of pressure, narcoses with or without super-pressure according to the stage of operation.

Fig. 1 in the drawing is a diagrammatic elevation partly in sect1on of an apparatus constructed according to the invention.

Fig. 2 is a section of a threeway cock in a position differing from that shown in Fig. 1.

The flask or vessel 1 contains the narcotic gas and the flask or vessel 2 the compressed oxygen. By way of the pressure reducing valves 3 and 4 the gases flow through the pipes 5 and 6 to the common shut-oand dosing valve or cock 7 and are mixed Within the pipe 8 forming a mixing chamber. The mixture flows through the pi e 8 into the breathing bag 9. The patient in ales the mixture of gas from this bag through an inhalation channel formed by the pipes 10 and 11, the check valve 12, the hose 13 and thelmask 14. The exhaled air flows through an exhalation channel formed by the hose 15, the check valve 16, the threeway cock 17, the cartridge 18 for absorbing the carbonio acid, the pipes 11 and 10 back into the bag 9. The easily movable valves 12 and 16 secure the movement of the :inhaled and exhaled air in the direction indicated by. arrows. f

The gas circulating in the describedsystem (breathing bag 9 with the pipes communicating with it) is subjected to super-pressure. A casing or container 19 of strong thick rubber or the like embraces the bag 9 so that the same forms a flexible wall subdividing the space of the casing 19 into two cells. The outer cell is continuously passed by a stream of compressed air which exerts on the breathing bag a substantially constant pressure whereby the compression of the gas withinsaid breathing bag lis maintained substantially constant and unaected by the volumetricl fluctuations of the breathing bag. For producing the super-pressure, by Way of example,

an injector pump 2O may be used, which may be operated by a second oxygen-pressure reducing valve21. The compressed oxygen is fed to the injector pump 20 by the pipe 22. The desired super-pressure from 1 to 10 cm. of a column of water will be regulated by a set-screw .24 adjusting the pressure exerted upon a blow-off-valve 25 mounted within a housing 23. The consumption of oxygen of the injector is slight', say 5 liters per minute, to produce a super-pressure current of 80 to 100 liters per minute. If o`n full or deep inl haling say 1 toll/2 liters of gas are taken from the bag 9 in one second, the super-pressure drops only negligibly, because at the same valve seat. When exhaling the bag 9 will:

time the same amount of air is fed by the inj ector and enters the bag or container 19. The lflow 0E valve 25 at this time allows only very little air to escape, as it scarcely bears onthe be iilled and at the same time compressed air escapes from the bag 19, the valve being raised from the seat without essential increase of super-pressure. The fluctuations of pres- 25 sure will remain within the permissible height of about 2 cm of a column of water. The super-pressure c-an be read oii' from the manometer 26.-

As may be gathered from the illustration all pipes communicate with the connectingor distribution-member 27. This is to be noted as an advantage because by this means the length of Vthe passages and thus fll fluctuations of pressure caused by the friction of o'r resistance in the lpipes are reduced to a minimum.

Since it is not possible to determine the amount of breathing gas required during the narcosis exactly according to the physiological consumption of gas and to avoid a deficiency of gas and therefore an under-pressure it is necessary to dose a certain surplus of gas. This surplus of gas will escape from the exlialation pipe by the-pipe 28 and the weakly loaded check valvev 29 into the bag 19. The

valve 29 will not open until within the circulation system formed by the inhalation channel j and the exhalation channel there is a superpressure which is a few mm. higher than the super-pressure in the bag 19. By this means i the entrance of injector air into the circulation pipes is prevented. The three-way cock 17 allows the varying of the ratio of the free section of the passage leading from the exhalation pipe 15 to the cartridge 18, to the free section of the channel formed by the pipe 20 and the blow-oifvalve 25, whereby the ratio of exhaled gas reconducted through thel cartridge into the breathing bag, to the exhaled gas blown off, may be adjusted.

At the commencementof the narcosis the threeway cock 17 is in the position shown in Fig. 2. As long as a certain degree of saturation of the blood with the narcotic gas is not obtained (during the first three to five minutes) a larger quantity than the amount oi.' gas required later on must be fed, generally such an amount which is necessary'for a full breathing. All of the exhaled air escapes into the atmosphere and no gas will pass into circulation through the cartridge 18 when the cock 17 is adjusted as shown in Fi g. 2. Otherwise the gas concentration and thereforethe narcotic eifect would be uncertain. During the preparatory narcosis, which is carried on without super-pressure untilafter the blood has been saturated and While the cartridge 18 is fully out of circulation as shown in Fig. 2 the injector 20 is inoperative, the cock 30 is closed and the valve 25 is unloaded. The surplus of gas thus can escape into the atmosphere without counter-pressure into the distribution member 27, and by the valve 25 into the atmos.

phere. As soon as super-pressure is required the cock 30 is opened and the valve 25 is adjusted or regulated by the handwheel 24,

While observing the manometer 26. It is i necessary that the mask fit gas-tight against the face of the patient. As an additional apparatus the known ether narcosis apparatus '31 is provided, which is operated by thev `mark on the dialfor ether. Generally ether narcosis is administered without super-pressure, and without carbonio acid absorption,

as shown by the position of the threeway cock 17 in Fig. 1.

The apparatus described above is a decided improvement in the art, because it enables severe operations in the inner breathing organs by using narcotic means which, as is Well established are not dangerous. Owing to the simple construction and operation of the apparatus it can be easily handled and can be employed in every medical room. The costs are slight and only little higher than gas narcosis without super-pressure.

1..I In an apparatus for administering inhalation gas, the combination comprising a casing, a flexible wall subdividing the space thereof into two cells, means delivering compressed inhalation gas to one cell, an inhalation conduit in communication with that cell, and a conduit for supplying a gas at super-atmospheric pressure to the second cell for producing a substantially constant super-atmospheric gas pressure therein, whereby the compression of the gas in the first cell is maintained substantially constant at super-atmospheric pressure.

2. In an .apparatus for administering inhalation gas, the combination comprising a casing, a flexible wall subdividing the space thereof into two cells, means for delivering compressed inhalation gas to one cell, an inhalation conduit in communication with that cell, adjustable means supplying compressed gas to the second cell and a blow-off valve in the. wall of the second cell, whereby a substantially constant gas pressure is maintained therein.

3. 'lhe combination set forth in clailn 2, in which the adjustable means lsupplying compressed gas to the second cell comprise an injector pump and a regulating valve associated therewith.

4. ln an apparatus for administering inlialation gases, the combination comprising a breathing bag, means for delivering compressed inhalation gas thereto, an'inhalation conduit in communication with said bag for withdrawingr gas intermittently therefrom whereby fluctuations in the volume of the bag are caused, and a casing enclosing the breathing bag, said easing being adapted to receive gas under pressure for maintaining a constant super-atmospheric gas pressure therein, whereby the compression of the as within said breathing bag is maintainer substantially constant and unaffected by the aforesaid volume fluctuations.

5. The combination set forth in claim 4 in which the meansk for maintaining a constant gas pressure in said casing comprise a pump feeding gas into the casing and an adjust able blow-off valve in communication with the casing.

(i. In an apparatus for administering inhalation gas, the combination comprising abreathing bag, means delivering compressed inhalation gas thereto, an inhalation conduit and an exhalation conduit, both in communication with the bag for withdrawing and reconducting alternatively the inhaled gas thereto and therefrom whereby fiuctuations in the volume of the bag are caused, an air purifying cartridge connected with the inhalation conduit, a casing enclosing the breathingr bag, a conduit for supplying a gas at super-atmospheric pressure to said casing for maii'itaining a constant super-atmospheric. gas pressure therein, whereby the compression of the gas within said breathing bag is maintained substantially constant and unatl'ected by the aforesaid volume fluctuations, and a valve for selectively connecting said exhalalior conduit with said cartridge or with said casing.

'i'. In an apparatus for administering inhalation gas, the combination comprising a breathing bag, means for delivering compressed inhalation gas thereto, an inhalation conduit and an exhalation conduit., both in communication with the breathing bag and adapted to conduct the gas in a com ressed condition back and forth between the reathing bag and the organs of respiration, a casing enclosing the breathing bag and adapted to receive gas under pressure for maintaining a constant super-atmospheric gas pressure therein, a pipe connecting the casing with the path of the gas stream circulating 1n the inhalation conduit, the exhalation conduit and the breathing bag, and a spring cont-rolled check valve in said pipe, whereb the difference between the pressure in sai casing and the pressure in the circulating stream is regulated.

8. The combination set forth in claim 7 in which the means for maintaining a constant gas pressure in said casing comprise an injector pump` delivering air to said casing, a conduit conducting pressure gas to the injector pump from the means which deliver compressed gas to the breathing bag, and an adjustable blow-off valve. in connnunication with said casing preventing an excessive pressure rise.

S). In an apparatus for administering inhalation gases, the combination of a mixing chamber having a flexible wall, a conduit for conducting the gases thereto from a source of supply, an inhalation conduit connected to said chamber for conducting the gases to the organs of respiration, an exhalation conduit for receiving the exhaled gases, a casing at least partly enclosing the flexible wall of said chamber, a conduit for conducting a gas under super-atmosphere pressure from a source of supply to said casing, whereby the gases in said chamber are maintained under super-atmospheric pressure, a conduit leading from said casing and communicating with said chamber, and a check valve in said condut for limiting the maximum pressure in said chamber to that in said casing.

10. In an apparatus for administering anaesthetic inhalation gases, the combination comprisin a casing, a flexible wall dividing the space t ereot into a pressure chamber and a mixing chamber, a conduit for feeding a gas under super-atmospheric pressure to said pressure chamber, means supplying a mixture of said gases into said mixin chamber, an inhalation conduit conducting t 1e mixture to the organs of respiration, an air purifying cartridge, an exhalation conduit provided with one assage leading through the cartridge bac to the mixing chamber, and with a second passage independent of the first passage. and ont of eonnnunication with the inhalation conduit except through said cartridge, a blow-off valve controlling said second passage, the latter being connected to said pressure chamber, and a, controlling valve adapted to vary the ratio of the free sections of said passages whereby the ratio of the exhaled gas recon'ducted through the cartridge into the breathing bag to the exhaled gas blown off into said pressure chamber may be adjusted.

11. In an apparatus for administering a mixture of anaesthetic gas and oxygen, the combination of a casing, a flexible wall dividing the space thereof into a pressure chamber and a mixing chamber, means delivering the mixture in a compressed condition into the latter, an inhalation conduit and an exhalation conduit, both in communication with the mixing chamber and adapted to conduct the mixture in a compressed condition back and forth between the mixing chamber and the organs of respiration, a conduit for conducting` a gas under pressure into said pressure chamber to maintain in said mixing chamber a substantially constant gas pressure exceeding the atmospheric pressure2 a. gas purifying car- A tridge in the exhalation conduit, a blow-off valve connected to said last-mentioned conduit, and a regulatin valve in said conduit for controlling the cx laled gas' streams passing through the cartridge and the blow-off valve. In testimony whereof I have signed my name to this specification.

ALEXANDER BERNHARD DRGER. 

